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LETTERS: Felicity Reynolds Good news is often ignored BMJ 2004; 329: 293 [Full text]

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Picture Accuracy Is Often Ignored

Alan P McGlennan   (1 August 2004)

Good news is yet again being obscured

FELICITY REYNOLDS   (2 August 2004)

Picture Accuracy Is Often Ignored 1 August 2004
Alan P McGlennan, Specialist Registrar Central London School of Anaesthesia Send response to journal: Re: Picture Accuracy Is Often Ignored	Editor - I was rather surprised to see the picture accompanying Professor Reynold's correspondence (BMJ Volume 29, p293). Although the letter and article were about epidural analgesia the picture was quite clearly that of a patient receiving a SPINAL needle. At the risk of sounding too pedantic, the practitioner was also evidently not using the full aseptic technique (i.e. including a gown) that most obstetric anaesthetic practitioners would advocate. Competing interests: None declared
Good news is yet again being obscured 2 August 2004
FELICITY REYNOLDS, EMERITUS PROFESSOR OF OBSTERIC ANAESTHESIA ST THOMAS' HOSPITAL, LONDON SE1 7EH Send response to journal: Re: Good news is yet again being obscured	There are several elements of this letter that I wish to disown. Firstly, my original opening sentence was not: "In their systematic review Liu et al show that epidural analgesia does not increase the caesarean section rate, which is welcome." - but rather: "Another systematic review showing that epidural analgesia does not increase the caesarean section rate is welcome." The crucial information, that this review was the latest of many, was deleted without my knowledge, and editorial strictures on the number of references precluded my citing any of the earlier evidence [1- 3], thereby making it appear that this was the first time the absence of any effect of epidural analgesia on the caesarean section rate had been demonstrated. This alteration yet again bears out my contention that GOOD NEWS IS OFTEN IGNORED - or even, dare I say it, suppressed. The second cuckoo that entered the nest is the illustration, to which I object on two grounds. Firstly, the patient is sitting instead of lying. In obstetrics it is important that the mother is recumbent so that the partner, who may be even more anxious than she, is seated and the two are face to face, he can rest his arms on the bed and hold her hand, for mutual comfort. If the mother is sitting, the partner is prompted to stand, thereby risking a faint, which is rendered more likely because he may be able to view the epidural insertion, thereby introducing a third patient into the already complex equation. Moreover in the sitting position spinal fluid pressure is increased, so accidental dural puncture is facilitated, while if the anaesthetist learns to cite epidurals with the patient sitting, s/he has difficulty in using the lateral position when the clinical situation demands it, as in epidural blood patching. Secondly, what are those horrid bare hairy arms doing? I suspect (and hope) that this is actually a photograph of a spinal insertion, whereas, as previously rehearsed in these very columns,[4] most UK anaesthetists wear gowns to cite epidurals. 1. Halpern SH, Leighton BL, Ohlsson A, Barrett JFR, Rice A. Effect of epidural vs parenteral opioid analgesia on the progress of labor. JAMA 1998;280:2105-10. 2. Leighton BL, Halpern SH. The effects of epidural analgesia on the progress of labor, maternal and neonatal outcomes: a systematic review. Am J Obstet Gynecol 2002;186:S69-77. 3. Zhang J. Klebanoff MA. DerSimonian R. Epidural analgesia in association with duration of labor and mode of delivery: a quantitative review. Am J Obstet Gynecol 1999:180:970-7. 4 Reynolds F. Epidurals and backache: again? (letter) BMJ 2002; 325: 1037. Competing interests: None declared